Compass - Contractor Safety Performance

• Project

  MK - Broad Ripple

  1234 Prospect

• Conducted on

  Date

• Prepared by

• Location
  Address

General Safety

• Are personnel active on the project?

  Yes

  No

  N/A
Contractor

• Contractor Name

• All personnel are wearing hard hats

  Safe

  At Risk

  N/A

• All personnel are wearing safety glasses

  Safe

  At Risk

  N/A

• All personnel are wearing high visibility clothing

  Safe

  At Risk

  N/A

• All personnel onsite have successfully completed orientation

  Safe

  At Risk

  N/A

• All personnel are conducting daily planning activities (Task Hazard Analysis)

  Safe

  At Risk

  N/A
Contractor

• Contractor Name

• Department of Labor and OSHA documentation is posted

  Yes

  No

  N/A

• Emergency Action Plan and escape routes are complete and readily available

  Safe

  At Risk

  N/A

• Safety Data Sheets are available for all materials on the project.

  Safe

  At Risk

  N/A

• Work area is clean and materials organized

  Safe

  At Risk

  N/A

• Lighting in all work areas is adequate to allow for clear view of all activities

  Safe

  At Risk

  N/A

• Ventilation in work area is effective

  Safe

  At Risk

  N/A

• Potable water is available to personnel

  Safe

  At Risk

  N/A

• 1 restroom per 20 personnel is available and clean

  Safe

  At Risk

  N/A

Mobile Equipment

• Is mobile equipment (i.e. earth moving equipment, lulls, fork trucks) being utilized on the project?

  Yes

  No

  N/A
Contractor

• Contractor Name

• Mobile equipment has been inspected

  Safe

  At Risk

  N/A

• Operator is functioning in a competent manner

  Safe

  At Risk

  N/A

• Spotter are being utilized to assist in backing up and protecting operator's blind spots

  Safe

  At Risk

  N/A

• Backup alarm and horn are operational

  Safe

  At Risk

  N/A

• Operator is wearing safety belt

  Safe

  At Risk

  N/A

• Pedestrians are aware and are staying clear of mobile equipment operation

  Safe

  At Risk

  N/A

• Operator has training for equipment being operated

  Safe

  At Risk

  N/A

• Is mobile equipment used in the building?

  Yes

  No

  N/A

• Floor is capable of supporting weight (point load, total per sqft)

  Safe

  At Risk

  N/A

• Are Scissor lifts being used?

  Yes

  No

  N/A
Contractor

• Contractor Name

• Scissor lift has been inspected

  Safe

  At Risk

  N/A

• Scissor lift is being operated on level surface

  Safe

  At Risk

  N/A

• Personnel have feet on deck of scissor lift

  Safe

  At Risk

  N/A

• Chain on scissor lift is attached

  Safe

  At Risk

  N/A

• Are aerial lifts being used?

  Yes

  No

  N/A
Contractor

• Contractor Name

• Aerial lift has been inspected

  Safe

  At Risk

  N/A

• Ground is suitable for safe operation

  Safe

  At Risk

  N/A

• Personnel in basket are utilizing fall protection (i.e. harness and lanyard) and are tied off to the basket

  Safe

  At Risk

  N/A

• Personnel in basket are only working off basket platform (i.e. not standing on rails)

  Safe

  At Risk

  N/A

• Operator of aerial lift is doing so in a safe manner

  Safe

  At Risk

  N/A

• Personnel are clear below working area of elevated aerial lift

  Safe

  At Risk

  N/A

Cranes, Rigging, Hoisting, Suspended Loads

• Are cranes being utilized?

  Yes

  No

  N/A
Contractor

• Contractor Name

• Operator has training certification on person and available

  Safe

  At Risk

  N/A

• Operator appears to be competent in running crane

  Safe

  At Risk

  N/A

• Crane has annual and daily inspection

  Safe

  At Risk

  N/A

• Barriers around crane are established to protect for swing radius

  Safe

  At Risk

  N/A

• Outriggers and cribbing is effectively utilized

  Safe

  At Risk

  N/A

• If necessary, a critical lift plan is completed and approved

  Safe

  At Risk

  N/A

• Are suspended loads present?

  Yes

  No

  N/A
Contractor

• Contractor Name

• Personnel rigging and signaling are trained

  Safe

  At Risk

  N/A

• Rigging equipment has been inspected and is in good working condition

  Safe

  At Risk

  N/A

• Loads are balanced and rigged correctly

  Safe

  At Risk

  N/A

• Suspended loads are away from personnel

  Safe

  At Risk

  N/A

• Tag lines are used on all suspended loads

  Safe

  At Risk

  N/A

• Entire swing of load is protected from personnel being beneath the load

  Safe

  At Risk

  N/A

Ladders

• Are ladders being used?

  Yes

  No

  N/A
Contractor

• Contractor Name

• Ladders are free of damage and defects

  Safe

  At Risk

  N/A

• Ladders are set up and secured

  Safe

  At Risk

  N/A

• Personnel using ladder is maintaining three points of contact

  Safe

  At Risk

  N/A

• Ladders are made of fiberglass

  Safe

  At Risk

  N/A

Public Protection

• Does the work potentially interact with public and/or staff?

  Yes

  No

  N/A
Contractor

• Contractor Name

• The perimeter of the work area identified and protected

  Safe

  At Risk

  N/A

• Signage is present identifying work areas as "Construction Zone"

  Safe

  At Risk

  N/A

Fall Protection

• Are personnel working with their feet at/or above 6 feet?

  Yes

  No

  N/A
Contractor

• Contractor Name

• Are guardrails present

  Yes

  No

  N/A

• Top rail, mid-rail, and toe board present in all areas

  Safe

  At Risk

  N/A

• Toprail, mid-rail, and toe board sturdy (200 pounds of force) and in good condition

  Safe

  At Risk

  N/A

• Top rail, mid-rail, and toe board at proper heights (42” +/-3”, 21” +/-3”, within an inch of deck)

  Safe

  At Risk

  N/A

• Guardrail is surfaced as to prevent injury to an employee from punctures or lacerations, and to prevent snagging of clothing

  Safe

  At Risk

  N/A

• Is a harness, lanyard, and anchor point being used?

  Yes

  No

  N/A

• Anchor point is secure and can withstand 5,000 pounds

  Safe

  At Risk

  N/A

• Lanyard is securely affixed to anchor point and harness

  Safe

  At Risk

  N/A

• Lanyard is in good condition and the correct type of lanyard is utilized for working environment

  Safe

  At Risk

  N/A

• Harness fits well and is in good condition

  Yes

  No

  N/A

• Are covers being utilized to protect floor penetrations greater than 2 inches in diameter?

  Yes

  No

  N/A
Contractor

• Contractor Name

• Covers are secured and labeled as "HOLE

  Safe

  At Risk

  N/A

• Material used for floor penetration protection has sufficient load capacity for activity in work area

  Safe

  At Risk

  N/A

• Are stairways present?

  Yes

  No

  N/A
Contractor

• Contractor Name

• There is at least one handrail and one system per unprotected side

  Safe

  At Risk

  N/A

• The handrail is 37”-30” off the face of the tread

  Safe

  At Risk

  N/A

• The handrail is surfaced as to prevent injury to an employee from punctures or lacerations, and to prevent snagging of clothing

  Safe

  At Risk

  N/A

• Stairways are free and clear of slippery materials

  Safe

  At Risk

  N/A

• An effective system(Mid-rails, screens, mesh, intermediate vertical members, or equivalent intermediate structural members) is in place between the handrail and the tread

  Safe

  At Risk

  N/A

• Handrails provide adequate handhold to prevent personnel from falling

  Safe

  At Risk

  N/A

Electrical

• Is electrical power for tools, equipment, lighting, etc. being used?

  Yes

  No

  N/A
Contractor

• Contractor Name

• Electrical panels and/or cabinets are identified and secured

  Safe

  At Risk

  N/A

• Electrical cords, pugs, and/or outlets are in good working condition

  Safe

  At Risk

  N/A

• Ground Fault Circuit Interrupter (GFCI) are used with all electrical tools and equipment

  Yes

  No

  N/A

• Electrical cords are out of walkways

  Safe

  At Risk

  N/A

• Electrical cords do not run through doors or wall openings without being protected from damage

  Safe

  At Risk

  N/A

• Temporary lighting has cages and bulbs intact

  Safe

  At Risk

  N/A

• Is there lockout/tagout being used?

  Yes

  No

  N/A
Contractor

• Contractor Name

• The LOTO plan is being followed

  Safe

  At Risk

  N/A

• All energy sources have been determined and rendered inoperative

  Safe

  At Risk

  N/A

• Tags or locks are in place at all points of possible energy release

  Safe

  At Risk

  N/A

Fire Protection

• Are fire extinguishers present on the site?

  Yes

  No

  N/A
Contractor

• Contractor Name

• Fire extinguishers have an annual inspection and have been inspected for the current month

  Safe

  At Risk

  N/A

• Fire extinguishers are located at each floor level of the stairwell

  Safe

  At Risk

  N/A

• There are sufficient extinguishers(100’ of travel and/or 1 per 3,000sqft) for the job

  Safe

  At Risk

  N/A

• Fire extinguishers are available at all access and egress points

  Safe

  At Risk

  N/A

• Are flammable and/or combustible materials being stored on the project?

  Yes

  No

  N/A
Contractor

• Contractor Name

• All flammable and combustible materials are stored in a safe location

  Safe

  At Risk

  N/A

• Location of stored flammable and combustible materials are identified with signage and secure

  Safe

  At Risk

  N/A

• Compressed gas cylinders are secured, upright, and are capped

  Safe

  At Risk

  N/A

• Are grinding, cutting, welding or any other spark producing activities being conducted?

  Yes

  No

  N/A
Contractor

• Contractor Name

• If required, are Hot Work Permits completed, reviewed, and approved?

  Safe

  At Risk

  N/A

• A fire extinguisher is available for the activity being conducted

  Safe

  At Risk

  N/A

• All flames, sparks and/or slag is contained from spreading (i.e. floor penetrations, stairways, etc.)

  Safe

  At Risk

  N/A

• Gauges, hoses, cables, and welding leads in good working condition

  Safe

  At Risk

  N/A

• Flash arrest protection is present with torches

  Yes

  No

  N/A

• When welding, flash protection is used

  Yes

  No

  N/A

• Are Fire Hydrants accessible to the site?

  Yes

  No

  N/A
Contractor

• Contractor Name

• The areas around the hydrant(s) are accessible to fire department

  Safe

  At Risk

  N/A

• There are clear paths to the building from the hydrant(s)

  Safe

  At Risk

  N/A

• The No Smoking Policy is enforced

  Safe

  At Risk

  N/A

Material Storage

• Is construction material to be used at a future date stored on site?

  Yes

  No

  N/A
Contractor

• Contractor Name

• Walkways are free of stored material

  Safe

  At Risk

  N/A

• Is material stored outside?

  Yes

  No

  N/A

• Material is protected from the elements (wind, rain, snow)

  Safe

  At Risk

  N/A

• Clear access to material is maintained

  Safe

  At Risk

  N/A

• Is material stored inside?

  Yes

  No

  N/A

• The floor is rated to withstand weight of material (point loading, total per sq/ft)

  Safe

  At Risk

  N/A

• Material is secured from movement (rolling, scooting, falling, tipping)

  Safe

  At Risk

  N/A

• Is trash and debris stored on site?

  Yes

  No

  N/A
Contractor

• Contractor Name

• Proper trash receptacles are used

  Safe

  At Risk

  N/A

• Nails or impalement hazards are removed from all material

  Safe

  At Risk

  N/A

Tools

• Are tools being utilized on the job site?

  Yes

  No

  N/A
Contractor

• Contractor Name

• Guards are in place

  Safe

  At Risk

  N/A

• Handles are in place

  Safe

  At Risk

  N/A

• Hand tools are in good working order

  Safe

  At Risk

  N/A

• Proper tool is being used for the job

  Safe

  At Risk

  N/A

Trench and Excavations

• Are there trenches or excavations on site?

  Yes

  No

  N/A
Contractor

• Contractor Name

• 811 locates are done

  Safe

  At Risk

  N/A

• Daily inspection has been done

  Safe

  At Risk

  N/A

• Access/egress is within 25' of travel

  Safe

  At Risk

  N/A

• Sloping, benching or shoring is in accordance with Trench Form

  Safe

  At Risk

  N/A

Scaffold

• Are scaffolds used on the jobsite?

  Yes

  No

  N/A
Contractor

• Contractor Name

• Daily inspection by competent person has been completed

  Safe

  At Risk

  N/A

• Guardrails or fall protection is in place for decks over 10’

  Safe

  At Risk

  N/A

• Access to platforms is sufficiently provided

  Safe

  At Risk

  N/A

• Bracing is installed and sufficient

  Safe

  At Risk

  N/A

• Mudsills, plates or wheels are in place

  Safe

  At Risk

  N/A

• Scaffold is not overloaded

  Safe

  At Risk

  N/A

• Scaffold has tie in or outriggers at 20'

  Safe

  At Risk

  N/A